Tamoxifen and proliferation of vaginal and cervical epithelium in postmenopausal women with breast cancer

Objective: The estrogenic effect of tamoxifen on vaginal and cervical epithelium in postmenopausal women with breast cancer is evaluated. Study Design: The tamoxifen group consisted of 92 postmenopausal breast cancer patients, the control group I of 30 postmenopausal women with breast cancer receiving no endocrine therapy and the control group II of 40 postmenopausal women without primary breast cancer taking no hormones. We determined the maturation index and the incidence of endocervical cell hyperplasia and metaplasia in cervical and vaginal smears. Results: The maturation index increased under tamoxifen within the first 24 months from 0.4011 before taking tamoxifen (n = 56) to 0.6039 (n = 138, P<0.0001). The maturation index in the group treated with tamoxifen was statistically significantly higher (P<0.0001) than in the control groups (control group I: 0.3975, P<0.0001; control group II: 0.4102, P<0.0001). Under therapy with tamoxifen endocervical cell hyperplasia (P=0.00156) and metaplasia (P=0.00123) appeared significantly more often. Conclusion: An apparent increase not only of the incidence of endocervical cell hyperplasia and metaplasia but also of the maturation of the vaginal epithelium caused by the estrogenic effect of tamoxifen could be demonstrated.     

Hyaluronan in follicular fluids and fertilization of oocytes

Objective: To determine the concentrations of hyaluronan, E₂, and progesterone in follicular fluids (FFs) and the incidence of apoptotic granulosa cells. Also, to examine the relationship between the concentration of hyaluronan and follicular steroids, the incidence of apoptotic cells, and the fertilizability of the oocyte in the same follicle.

Design: Samples of 130 follicles were retrospectively analyzed for hyaluronan and steroids and the incidence of apoptotic cells.

Setting: The reproductive center in Yamagata University Hospital.

Patient(s): Forty women infertile because of tubal damage or unknown causes undergoing IVF treatment were selected.

Intervention(s): The samples were collected from follicle aspirations.

Main Outcome Measurement(s): The concentrations of hyaluronan and steroids in FFs, the incidence of apoptotic granulosa cells, and oocyte fertilizability.

Result(s): The levels of hyaluronan in FF were found to correlate positively with P (r=0.444, P<0.0001) and the incidence of apoptotic cumulus granulosa cells (r=0.387, P=0.002) and inversely with E₂ (r = −0.601, P<0.0001) and free T (r = −0.344, P=0.001). The concentration of hyaluronan in FFs containing a subsequently fertilized oocyte after insemination was significantly lower than that in FFs containing a subsequently unfertilized oocyte (P=0.0005) (fertilized, 50.0 ± 2.6 ng/mL; triploidy, 59.1 ± 6.8; and unfertilized, 66.9 ± 5.9).

Conclusion(s): The concentration of hyaluronan in FF is an indicator for estimation of oocyte viability for fertilization.     

Meconium stained amniotic fluid in very low risk pregnancies at term gestation

Objective: To determine the prevalence and clinical significance of meconium stained amniotic fluid (MSAF) in a low risk population at term gestation and to investigate whether MSAF is a predictor for intrapartum and neonatal morbidity. Methods: A very low risk population including 37 085 consecutive deliveries at term composed the study population. A cross-sectional study was conducted and two groups of patients were identified according to the presence (n=6164) or absence (n=30 921) of meconium in the amniotic fluid at delivery and the outcomes of the two groups compared. Results: The prevalence of MSAF was 16.6%. The incidence of cesarean section (5.6% vs 2.3% P<0.01), instrumental deliveries (3.2% vs 1.8% P<0.01), fetal distress (6.5% vs. 2.1% P<0.01), clinical chorioamnionitis (0.2% vs. 0.1% P<0.01), post-partum infection (0.5% vs. 0.2% P<0.01), 1-minute Apgar score <3 (1.9% vs. 1.1% P<0.01), small for gestational age (7.4% vs. 6.4% P<0.01). was significantly higher in the MSAF compared with the clear amniotic fluid group. Intrapartum and neonatal mortality in this low risk population was significantly higher in the MSAF group ( ) compared with women with clear AF ( ). Conclusions: MSAF in a low risk population at term gestation is a predictor for adverse perinatal outcome and peripartum complications.     

Human oviductal cells reduce the incidence of apoptosis in cocultured mouse embryos

Objective: To investigate the effect of human oviductal cell coculture on the incidence of apoptosis in mouse embryos.

Design: Experimental laboratory study.

Setting: University gynecology unit.

Patient(s): Fallopian tubes were obtained from patients undergoing hysterectomy.

Intervention(s): Mouse embryos were cocultured with human oviductal cells.

Main Outcome Measure(s): Blastocyst development, allocation of inner cell mass (ICM) and trophectoderm (TE) in blastocyst, and apoptosis in embryos.

Results: Oviductal cells significantly enhanced the blastulation (38%) and hatching rate (22%) of the cocultured zygotes. The corresponding values in medium alone culture were 21% and 9%, respectively. The cocultured embryos also had higher blastomere count at blastocyst stage (P<0.005). This was due to increase in both the cell count of ICM (P<0.05) and TE (P<0.001). Coculture reduced the incidence of apoptosis in the cultured morula and blastocyst from 38% and 48% to 16% (P<0.001) and 27% (P<0.05), respectively. The number of apoptotic blastomeres per morula (1.5 ± 0.6; P<0.005) and blastocyst (2.3 ± 0.7; P<0.005) after coculture was also significantly lower than that of the corresponding control (morula, 2.1 ± 0.8; blastocyst, 3.5 ± 1.1).

Conclusion(s): Human oviductal cells improved mouse embryo development partly by decreasing the incidence of apoptosis.     

The effects of clomiphene citrate on normally ovulatory women

Objective: To investigate the efficacy of clomiphene citrate (CC) on normally ovulatory women who complained of infertility.

Design: A randomized study.

Setting: University Hospital.

Patient(s): Thirty-three normally ovulatory women with unexplained infertility.

Intervention(s): Eighteen women received CC at a 50-mg dosage. Fifteen women received no ovulation-induction drugs.

Main Outcome Measures: The pregnancy rate (PR) per patient, the PR per cycle, and the cumulative pregnancy rate.

Result(s): Seven patients in the CC group stopped taking CC, and observations were terminated because of antiestrogenic effects. The pregnancy rate (PR) per patient and the PR per cycle were significantly decreased (P < 0.005) in the CC group (4 of 18 [22.2%] and 4 of 66 [6.1%], respectively) than in the spontaneous group (11 of 15 [73.3%] and 11 of 52 [21.2%], respectively). Kaplan-Meier tests showed that the cumulative pregnancy rate in the CC group was significantly lower than in the spontaneous group (P <0.05). Five of seven patients who had stopped taking CC became pregnant in spontaneous cycles.

Conclusion(s): Administration of CC to normally ovulatory women is not efficacious in terms of increasing the pregnancy rate.     

Postpartum hysterectomy

Objectives: To review cases of postpartum hysterectomy regarding indications, risk factors and complications and compare them with cases of emergency cesarean section. Methods: We conducted a retrospective chart review study of 20 cases of postpartum hysterectomy and 20 cases of emergency cesarean section performed at Sinai Samaritan Medical Center, Milwaukee, Wisconsin, between January 1984 and January 1994. Emergency postpartum hysterectomies were compared with emergency cesarean sections regarding obstetric history, placental location, operative time, blood loss, blood transfusion, intra- and postoperative complications and length of hospitalization. Emergency hysterectomies were reviewed according to their indications for the incidence of complications and length of hospitalization. Pathological diagnoses of the hysterectomy specimens were reviewed. Statistical analyses were performed using the two-tailed Student's t-test and Fisher's exact test. Results: Placenta accreta was the most common indication for emergency postpartum hysterectomy. Prior cesarean section and/or placenta previa were risk factors. Emergency hysterectomies were associated with longer operating times (P < 0.0001), greater blood loss (P < 0.0001), more transfusions (P < 0.001), postoperative complications (P < 0.01), secondary surgeries (P < 0.01) and longer hospitalizations (P < 0.0001) than cases of emergency cesarean section. Conclusions: Emergency postpartum hysterectomy is associated with significant blood loss, need for transfusion, postoperative complications and longer hospitalization partly because of its indications. The combination of prior cesarean section and current placenta previa should alert the obstetrician that an emergency postpartum hysterectomy may be needed.     

Pregnancy in patients with previous successful renal transplantation

Objective: To evaluate the risk factors affecting pregnancy, perinatal outcomes, and short-term graft condition in women who underwent renal transplantation. Method: Between May 1998 and January 2005, the histories of 20 pregnancies in 17 renal transplant recipients were reviewed retrospectively at the Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital. Result: There were significant associations between high serum creatinine level (> 1.5 mg/dL) prior to pregnancy and preterm delivery (P = 0.04), and between short interval between transplantation and pregnancy (< 2 years) and increased rate of cesarean sections (P = 0.04). There were no significant changes in serum creatinine levels during pregnancy in these women, and there were no acute rejection and graft loss during pregnancy or in the 6 months following delivery. Conclusion: These findings suggest that, although pregnancy does not adversely affect short-term renal allograft function, the rates of obstetric and perinatal complications are increased. Risk factors present before conception are a short interval between renal transplantation and pregnancy and poor renal function.     

A comparison of two methods of labor induction with vaginal misoprostol

Objectives: To evaluate if labor induction with 50 μg of vaginal misoprostol twice per day is as effective as and safer than 100 μg used once per day. Methods: Misoprostol was used to induce labor in 204 consecutive pregnant women assessed as needing labor induction, 104 at the University Hospital of the West Indies in Kingston, Jamaica, and 100 at the Victoria Jubilee Hospital, also in Kingston. At the former institution the women were administered 100 μg of misoprostol once per 24 h and at the latter 50 μg every 12 h. The doses were repeated if there was no cervical change or if the woman was not in labor. Bishop scores were determined before initiation of induction and again 12 h later. Women's records were reviewed after 24 h to determine delivery outcome. Results: The indications for labor induction were similar in each group. There was no significant difference in the group demographics. In the group given 50 μg of misoprostol twice per day the mean time±S.D. from insertion of misoprostol to delivery was significantly shorter than in the other group (560.14±269.20 min vs. 729.90±471.65 min; P<0.01), and the percentage of women who were delivered within 12 h was higher (75% vs. 56.8%; P<0.002). There was no significant difference between the two groups in the rate of cesarean births, the need for oxytocin, or blood loss. Only two patients experienced uterine hyperstimulation, both in the group that had received 100 μg of misoprostol per day. There was no significant difference between the two groups in the birthweight of the neonates and in the number of neonates with Apgar scores less than 7 at 1 min and 5 min. There were, however, significantly fewer neonates who needed resuscitation (6% vs. 14.7%; P=0.04) and admission to the special care nursery (7% vs. 17%; P=0.03) in the group that had received 50 μg of misoprostol twice per day. Conclusions: A dose of 50 μg of misoprostol twice per day appears to be more efficient and safer than a dose of 100 μg once per day, but this may partially be due to weaknesses in the study design.     

Calcium to creatinine ratio in a spot sample of urine for early prediction of pre-eclampsia

Objectives: Based on the fact that urinary calcium excretion decreases in pre-eclampsia, this study was designed to determine the predictive value of calcium to creatinine ratio in a spot urine sample. Methods: The calcium to creatinine ratio was measured in a spot urine sample of 102 normotensive women at 20–24 weeks’ gestation who attended the prenatal care clinic of the Shiraz University of Medical Sciences. The women were followed-up until delivery and grouped according to pre-eclampsia occurrence. The prevalence of pre-eclampsia was measured and compared with the calcium to creatinine ratio. Results: Ninety-four women remained normotensive during pregnancy and eight developed pre-eclampsia. Mean age, gestational age at the beginning of the study, and gestational age at delivery did not differ significantly between the two groups. Mean urinary calcium concentration (15.9±8.5 mg/dl in normotensive vs. 10.2±7.5 mg/dl in pre-eclamptic women), and mean birth weight (3192±336.3 g vs. 2712±468.9 g) were significantly lower in pre-eclamptic patients (P=0.03 and 0.005, respectively). Mean calcium to creatinine ratio was also significantly lower in the pre-eclamptic group (P<0.03). Conclusions: Single urine calcium to creatinine ratio may be an effective method for screening women at greatest risk for pre-eclampsia.     

The function of sildenafil on female sexual pathways: a double-blind,cross-over,placebo-controlled study

Objectives: To determine the changes, if any, on female sexual pathways using sildenafil (primary outcome), and to verify the safety of this drug (second outcome). Study design: Following previous research on symptomatic women, we wanted to study the effects of sildenafil on asymptomatic women. We would like to make it clear from the outset that this study is part of an ongoing line of research and this drug, and others of its type, should be used under strict medical supervision only on symptomatic patients. A randomized double-blind cross-over, placebo-controlled study was conducted at the Family Planning Centre of the Group for Sexological Research, Department of Microbiological and Gynecological Science, School of Medicine, University of Catania, Italy. Sixty-eight healthy volunteer women aged 19–38 years, asymptomatic for sexual disorders, were enrolled. The study consisted of 4 weeks sildenafil, 2 weeks washout, and 4 weeks placebo, by two possible sequences: sildenafil 50 mg, washout, placebo; or placebo, washout, sildenafil 50 mg. Efficacy of sildenafil was assessed by the Personal Experiences Questionnaire (PEQ) based on the 5-point Likert scale. The questionnaire quantified subjective sexual aspects at baseline, during washout, after treatments, and at the follow-ups. Statistical analysis was done with the Wilcoxon’s rank-sum test and Student’s t-test. Results: 50/68 women completed the study at the first follow-up, and 38 women reached the second follow-up. Six women withdrew because of adverse events. Sildenafil improved arousal (P<0.001), orgasm (P<0.05), and enjoyment (P<0.001) with respect to placebo. Significant differences were noted during sildenafil usage with respect to the baseline for arousal (P<0.01), orgasm (P<0.001), and sexual enjoyment (P<0.001). The adverse events were transient and mild or moderate. Conclusions: Our study suggests that sildenafil acts on the different sexual pathways in healthy women, improving their sexual experience. This study could help to understand the physiologic and pathophysiologic aspects of female sexuality. In comparison with current psychosexual therapies, which are long-term, compliance would be improved with use of this drug. Additional studies are required to define the use of sildenafil in a clinical setting.     

Attitudes, management and consequences of nausea and vomiting of pregnancy in the United States and Canada

Background: Nausea and vomiting of pregnancy (NVP) affects a large proportion of pregnant women. In 1983, Bendectin^®, the only FDA-approved drug for NVP, was removed from the market by its manufacturer due to legal costs based on claims of teratogenicity, which were subsequently proven to be unsubstantiated. In Canada, a generic form of Bendectin^® (Diclectin^®; a doxylamine/pyridoxine combination) has continued to be available, with increasing use over the last few years. Objective: To characterize the attitudes, management and consequences of NVP among pregnant women in the USA, where no approved drug for NVP is available, and in Canada, where such a drug is available. Design: Prospective, observational study. Results: Women suffering from NVP (N=1444) were interviewed, of which 42% were American and 58% were Canadian. The two groups had similar maternal characteristics and a similar distribution of severity of NVP, although among Canadian women the NVP continued for slightly longer. American respondents were treated significantly more often by an obstetrician as their primary caregiver, were more commonly advised by their caregiver to change their diet and/or lifestyle and to use non-pharmacological agents to manage their NVP, and more often perceived anti-emetics as posing an increased risk for malformations (all P<0.001). Canadian respondents reported a family physician as their primary caregiver significantly more often, were more commonly advised to take anti-emetic medications and perceived their NVP as causing a concern to their unborn (all P<0.001). American women experienced significantly larger weight loss, more hospitalizations and more time lost from paid work. Conclusions: Lack of an approved drug for symptoms of NVP may be associated with unwarranted and preventable adverse health effects. Because this is an observational study, these associations do not necessarily prove causation.     

Transcutaneous electrical nerve stimulation (TENS) for adjuvant pain-relief during labor and delivery

Objective: We examined the efficacy of transcutaneous electrical nerve stimulation (TENS) in general and the new Freemom TENS device (LifeCare, Israel) in particular, for pain relief during labor and delivery. Methods: The study group consisted of 104 women. Forty-six nulliparas (44.2%) and 58 multiparas (55.8%), all of whom used the TENS device for pain relief during labor. All participants completed a questionnaire on the degree of pain relief afforded them by TENS during the delivery and related questions. The objective evaluation was based on the documented labor and delivery parameters including medical interventions during delivery. Results: The majority of subjects (72% of the nulliparas and 69% of the multiparas) considered TENS effective for the relief of pain during labor. Most of them (67% of the nulliparas and 60% of the multiparas) responded positively to the use of TENS in future deliveries. Sixty-five percent of the multiparas considered TENS at least as effective as the other pain relief methods they had used before. TENS significantly reduced the duration of the first stage of labor P<0.001 for nulliparas, P<0.005 for multiparas and it significantly decreased the amount of analgesics administered to individual patients. No significant difference was found in fetal heart rate tracings, Apgar scores and cord blood pH between the study group and an equal number of matched controls who used other forms of pain management. Conclusions: TENS is an effective non-pharmacological, non-invasive adjuvant pain relief modality for use in labor and delivery. TENS application reduced the duration of the first stage of labor and the amount of analgesic drug administered. There were no adverse effects on mothers or newborns.     

Abdominal wall endometriomas

Objective: To investigate the clinical characteristics, treatment, and factors of recurrence of abdominal wall endometriomas (AWE). Method: Sixty-four cases of AWE diagnosed at Peking Union Medical College Hospital (PUMCH) from 1983 to 2003 were reviewed retrospectively. Result: There was an AWE incidence of 0.044% among the parturients undergoing cesarean section at PUMCH, of whom 87.5% had the typical complaint of an enlarging mass and pain during menstruation. Among these women, 62 underwent low abdominal surgery for endometrioma (2 for primary umbilicus endometrioma); 2 women with small endometriomas opted for a temporary medical solution and had relief after menopause. The latent period of AWE positively correlated to the women's age at onset of symptoms (P < 0.001). Of the 62 women who underwent local excision, 19 had an unsatisfactory experience with medical management. There were 5 recurrences and 1 evolution to malignancy during a mean follow-up of 83.7 months. Recurrence was closely related to the size and depth of lesions. Conclusion: Because of its typical clinical manifestations, abdominal wall endometriomas could be diagnosed before pregnancy. Surgical excision is the only effective treatment and wide local excision with clear margins is the key point to prevent recurrence.     

Transvaginal color Doppler ultrasonography for prediction of pre-cancerous endometrial lesions

Objective: To determine whether measurements of blood flow in endometrial and uterine vessels by transvaginal color Doppler ultrasonography was valuable in the diagnosis of a neoplastic endometrial pathology (hyperplasia and carcinoma) in women with abnormal bleeding. Methods: This is a prospective study and included 105 post-menopausal women and 33 pre-menopausal women with abnormal uterine bleeding. All subjects underwent transvaginal color Doppler ultrasonography. We investigated whether obtained results were correlated with histopathological findings. Results: There was no significant difference in the mean±S.D. RI of the left and the right uterine arteries, intramyometrial arteries and endometrial arteries between patients with neoplastic and non-neoplastic endometrium on histopathological examination. Doppler's velocity waveforms of small endometrial blood vessels could be detected in 9% of the women with non-neoplastic endometrium and in 42% of the women with neoplastic endometrium (P<0.05). The mean±S.D. of the endometrial thickness was significantly higher in the women with neoplastic endometrium than that of the women with non-neoplastic endometrium (16.6±6.1 mm vs. 9.5±4.7 mm, P<0.05). Conclusion: Doppler's velocity waveforms of uterine vessels coupled with transvaginal ultrasonography are not valuable enough to replace histopathological examination in the diagnosis of a neoplastic endometrial pathology. However, it may be helpful in cases in which invasive techniques are difficult to perform and in the differentiation of a certain group of patients at little risk of endometrial carcinoma.     

Timed intercourse after intrauterine insemination for treatment of infertility

Objective: To compare the pregnancy rates, between intrauterine insemination (IUI) followed by timed intercourse and IUI only for treatment of the infertile couples. Study design: A prospective study of two different protocols of intrauterine insemination in two hundred and one infertile couples with a normal spermiogram was carried out. Of these, 101 couples were treated with IUI alone and 100 couples had both IUI and timed intercourse within a 12-18 h period. The pregnancy rates were compared between groups. Results: The characteristics of the two groups were similar in terms of the mean age, as well as the duration and causes of infertility. The cycle characteristics following follicular stimulation were also similar between two groups. The pregnancy rate per cycle increased with increasing numbers of total motile sperm per insemination in the IUI alone group (P=0.045). Timed intercourse increased pregnancy rate in patients with lower motile sperm number (<40×10⁶) (27.7% versus 10.5%, P=0.023), but not in patients with higher sperm number (≥40×10⁶) (25.7% versus 22.7%, P=0.671). Conclusions: In IUI with low number of motile sperm inseminated, timed intercourse significantly increases the pregnancy rates over IUI alone in infertile couples with a normal sperminogram. This alternative treatment appears to be a practical, simple, and inexpensive addition that improves the pregnancy rate in patients receiving ovulation induction and intrauterine insemination program.     

Effect of long-term hormone replacement therapy on the bone in ovariectomized women with cancer

Objective: To evaluate longitudinally the effectiveness of long-term hormone replacement therapy (HRT) in preserving the bone mineral density (BMD) over a 5-year period in ovariectomized patients treated for gynecologic malignancies. Methods: A total of 70 pre-menopausal women ovariectomized for gynecologic malignancies at our hospital were divided non-randomly into two groups: HRT (+) group (n=59) and HRT (−) group (n=11). HRT was administered in a sequential regimen of 0.625–1.25 mg conjugated estrogen for 24 days and 5–10 mg medroxyprogesterone acetate for 10 days. Results: The BMD of the lumbar vertebrae decreased significantly in the HRT (−) group (pre-operative BMD was 91.8%, 91.0% and 91.3% at 1, 2 and 3 years post-ovariectomy), but no decrease in the BMD was observed in the HRT (+) group (pre-operative BMD was 98.4%, 99.0%, 99.4%, 98.8% and 98.7% at 1, 2, 3, 4 and 5 years post-ovariectomy); the difference in BMD between the two groups was statistically significant (P<0.01). Serum alkaline phosphatase levels were significantly lower in the HRT (+) group than in the HRT (−) group (P<0.01). There were four recurrences of cancer in the HRT (+) group. Conclusion: HRT appeared to have beneficial effects on bone metabolism by maintaining BMD for 5 years in ovariectomized patients for gynecologic malignancies.     

Diurnal nonstress test variations in the human fetus at risk

Objective: To compare the results of the nonstress test (NST) performed at 9:00 PM and 9:00 AM on women with high-risk pregnancies. Method: The NST was performed 2 h after a meal, at 9:00 AM and 9:00 PM, in a quiet room exposed to daylight, on 80 women with high-risk singleton pregnancies. Each session lasted 20 min. If the NST was nonreactive, the entire biophysical profile was immediately performed. The women's blood pressure was measured before, 10 min within, and at the end of the NST. Women who smoked or had uterine contractions were excluded from the study. Results: Diurnal nonstress test variations were manifested by a higher incidence of reactive NSTs and an increased number of fetal heart accelerations after 9:00 PM (82.5%) than at 9:00 AM (68.8%) (p < 0.027 P < 0.001). Conclusions: Evening appointments for fetal assessments, except in emergency conditions, may eliminate the need for additional tests such as the entire biophysical profile because of the decreased incidence of nonreactive NSTs. Evening NSTs would save time and decrease maternal anxiety.     

Influence of menstrual cycle on NK activity

Natural killer (NK) cells are CD3⁻ CD56⁺ and/or CD16⁺ cytotoxic lymphocytes that mediate first-line defense against various types of target cells without prior immunization. To assess the effect of the menstrual cycle and gender on NK activity we evaluated 30 healthy women (mean age 28.1 years, range 21–39) in follicular and luteal phases, 29 postmenopausal women (mean age 58.8 years, range 42–72) and 48 healthy men (mean age 31.6 years, range 21–40). In a flow cytometric test of NK activity, peripheral blood mononuclear effector cells were mixed with K562 targets cells labeled with DiO (3,3′-dioctadecyloxacarbocyanine perchlorate) at effector:target cell ratios of 40, 20, 10 and 5:1. Dead cells were stained with propidium iodide and results were expressed as lytic units per 10⁷ cells. In addition, progesterone levels were determined in the luteal phase of the menstrual cycle of healthy women by a chemiluminescence assay. Our results showed that (1) NK cytotoxicity was higher in the follicular than in the luteal phase of the menstrual cycle (P<0.0001); (2) postmenopausal women and men showed NK activity similar to women in the folicular phase but higher than women in the luteal phase of the menstrual cycle (P<0.05); and (3) there was no correlation between NK activity and levels of progesterone. The data suggest that progesterone does not influence NK activity directly and that other factors may explain the reduction of NK activity in the luteal phase of the menstrual cycle.     

Intracytoplasmic sperm injection could minimize the incidence of prematurely condensed human sperm chromosomes

Objective: To compare the fertilization and prematurely condensed human sperm chromosomes (PCCs) rates between two intracytoplasmic sperm injection (ICSI) techniques.

Design: A retrospective study.

Setting: The data were obtained from the University of British Columbia in vitro fertilization (IVF) laboratory.

Patient(s): ICSI cycles (n = 105) were performed for couples suffering from severe male-factor infertility and dysfunction of fertilization.

Intervention(s): Two types of ICSI techniques were used for ICSI procedures.

Main Outcome Measure(s): Fertilization and pregnancy rates in group B using the improved ICSI technique were compared with those of group A using the standard ICSI technique. Unfertilized oocytes from the two groups were studied with cytogenetic methods.

Result(s): Oocyte damage dropped from 14.8% in group A to 5.3% in group B. Normal fertilization for each group was 57.3% and 88.4%, respectively (P<.05). Pregnancy rate per egg retrieval was 15.6% in group A and 27.4% in group B (P<.05). PCCs occurred in 19.4% of unfertilized oocytes in group A and did not occur in group B.

Conclusion(s): This study indicates that ICSI not only yields high fertilization rates, but also minimizes the incidence of PCCs. It may be directly related to two crucial steps (immobilization of sperm and aspiration of oocyte cytoplasm) used in ICSI procedures. This study also suggests that it is possible to overcome one cause of IVF failure resulting from the formation of PCCs by using the improved ICSI technique.     

Effect of angiotensin-converting enzyme inhibitor on renal function in ovarian hyperstimulation syndrome in the rabbit

Objective: To investigate renal function and whether captopril prevents alterations in the handling of sodium and water in the ovarian hyperstimulation syndrome (OHSS) in the rabbit.

Design: Experimental study

Setting: Physiology laboratory.

Animal(s): Six female New Zealand white rabbits were used as controls, and 13 were hyperstimulated with gonadotropins.

Intervention(s): Saline or captopril.

Main Outcome Measure(s): Renal excretory and hemodynamic variables.

Result(s): The 3% extracellular volume expansion in OHSS animals induced a significant elevation in mean arterial pressure by 27%, although increments in natriuresis and diuresis were similar to those observed in controls. The OHSS group had impaired pressure-natriuresis sensitivity compared with controls (0.36 ± 0.07 μEq/min/g of Na excreted per mm Hg vs. 1.74 ± 0.45 μEq/min/g of Na excreted per mm Hg; P<.05. Captopril significantly reduced mean arterial pressure (P<.05) and shifted the pressure-natriuresis response to the left by 0.85 ± 0.17 μEq/min/g of Na excreted per mm Hg (P<.05).

Conclusion(s): In OHSS in the rabbit model, pressure-natriuresis sensitivity is impaired. Angiotensin II may play a significant role in this phenomenon, since angiotensin-converting enzyme inhibition normalized the pressure-natriuresis relationship.